No. 4 - "POPULATION AND HIV/AIDS'
The scourge of HIV/AIDS was the focus of attention 19 November at the fourth and final symposium in a series on population and the Millennium Development Goals (MDGs). The event, held at the UN's Dag Hammarskjold Library auditorium in New York, was sponsored jointly by the 19-member inter-governmental organization, Partners in Population and Development (PPD), and the Office of the High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing States (OHRLLS), United Nations.
Presentations were made by the Ambassadors and Permanent Representatives to the United Nations of Japan, Papua New Guinea and Zambia (Messrs. Toshiro Ozawa, Robert Aisi, and Mwelwa Musambichime, respectively), Dr. Jotham Musinguzi, Director of Uganda's Population Secretariat, and Dr. George Alleyne, the Secretary-General's Special Envoy on HIV/AIDS and Director Emeritus of the Pan American Health Organization (PAHO). Mr. Anwarul K. Chowdhury, Under-Secretary-General and High Representative of the OHRLLS, introduced the speakers in turn and served as moderator, while Mr. Jyoti Shankar Singh, Permanent Observer of Partners to the United Nations, served as discussant.
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Setting the tone for the closing symposium, Mr. Chowdhury expressed hope that the session would yield fruitful discussion and deepen the understanding of the social and political dimensions of the HIV/AIDS pandemic and its destructive effect upon the poorest and least developed nations. He recalled that HIV/AIDS was the focus of Millennium Development Goal 6, and that all efforts must be directed toward bringing knowledge about reproductive health and services, especially about methods of prevention and treatment, to the countries most afflicted. He said his agreement to co-sponsor the symposia series with PPD was a demonstration of his firm conviction that the MDGs could only be achieved where the population, reproductive health and family planning issues were taken fully into account. This, he added, was especially relevant in many of the small island nations with tiny populations, but with high growth rates and poor reproductive health services.
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Describing the impact upon Zambia, Mr. Musambachime said life expectancy, which should be at around 50, had dropped to about 37 and was heading lower. People were dying in their prime, and there was evidence that the ranks of the labour force-in the civil service and in the police forces-were being decimated, while traditional family support systems had broken down.
Hope for the future, he said, lay in building up healthcare services and bringing education and awareness to the people about HIV/AIDS. He expressed gratitude to the UN for its initiative in creating the global fund, which had attracted important bilateral donors, including the United States. Pointing to the notable success of Uganda in reducing rates of infection, he suggested it might serve as a model for Zambia-"to prevent and to treat"-assuming that sufficient funding could be made available.
Dr. Jotham Musinguzi, Director of Uganda's Population Secretariat in the Ministry of Finance and Economic Planning, agreed that his country might serve as an example to other countries for reducing infection rates, but he cautioned that "we still have a long way to go." He then traced the history of the growth of the disease in Uganda from the first known case in 1981 down to the situation in 1992, by which time the infection rate had reached as high as 18.5 percent in urban areas, and the most productive people were dying off, leaving childrearing to other relatives.
Fortunately, he added, the government then took action. At the initiative of the country's president, an AIDS commission was established in 1992 and religious leaders were enlisted to help in the essential outreach efforts. In fact, an Anglican bishop placed in charge. Policies and programmes were drawn up for all key ministries, including the military, education and agriculture. The major AIDS control campaign was tagged "ABC"; it called for A-abstinence, B-being Faithful and C-condom use. Ten years later, by 2002, AIDS prevalence had been brought down to 6.1 percent.
"The achievement is good," Dr. Musinguzi said, "but we are still in an epidemic situation, and it remains a major problem. There are still a lot of orphaned children out there." Analysing Uganda's limited success, he noted the key features: exercise of effective leadership at the highest political level; creation of an enabling environment for the implementation of policies that addressed the most vulnerable groups; decentralizing programme initiatives to the community level; involvement of the civil society, and good coordination to avoid duplication of efforts.
For the future, observed Dr. Musinguzi, Uganda will need to maintain the momentum of success despite emerging new challenges. He pointed to weakness in the infrastructural capacities at the peripheral level, where health services were poor and essential anti-retroviral drugs very expensive. A growing problem was the need to help those living with HIV/AIDS as well as the orphans of those who have died from the disease. More resources will be required if Uganda is to meet the challenge and continue its focus on reaching the goals of the 1994 ICPD and those of the Millennium Declaration.
According to H.E. Mr. Robert Aisi, Ambassador of Papua New Guinea, his country has taken the lead in the South Pacific region in efforts to fight the pandemic. The reason, he said, was that the infection prevalence rate had reached one percent among the population of 5.2 million people. While the rate appeared to be low, it was nevertheless indicative of a growing epidemic requiring remedial measures.
"We will need to mount a multi-pronged response," he declared. "This will require developing an awareness campaign involving all the stakeholders, including children and adolescents, parents, business and civic leaders. The prevalence rate will likely grow as our population shift continues towards urbanization."
Ambassador Aisi informed his audience that Papua New Guinea was doing a lot to bring awareness to the population; but he admitted, "we are still in a state of denial." He explained that there were strong taboos about sex that needed to be overcome to ensure effectiveness of advocacy programmes. There were other major cultural barriers, such as the difficulties in communicating with the population segmented by some 800 languages. "We will have to find champions among us to help us advocate to our people about the nature and dangers of HIV/AIDS and what can be done about it."
Pointing to a UNAIDS survey, Mr. Aisi said there were projections showing that the disease could wipe out large segments of the population, especially among those most at risk - the estimated 20,000 sex workers and their 50,000 clients. He then referred to a national plan drawn up for Papua New Guinea: "If we could do an effective programme in our country, it would serve as a model for other island nations in our region."
Sir George Alleyne, the Secretary-General's Special Envoy for HIV/AIDS in the Caribbean, explored the population issues as they are being impacted by the spread of HIV/AIDS to the island countries.
On the demographic side, he said, notwithstanding the growing prevalency rates of infection, there had not yet been any appreciable impact of HIV/AIDS-i.e., no significant increase in mortality rates, and no observable reduction in life expectancy. However, the rapidly rising prevalency rates of infection among young girls in the 15 to 24 age group was growing cause for concern, especially since this vulnerable cohort is unable, in the current socio-cultural climate, to negotiate in matters involving sex.
Concerning commitment of nations to reach the MDGs, Sir Alleyne referred specifically to Goal 6 with its challenge of reversing the spread of the disease by the year 2015. He despaired that this would be difficult for the Caribbean island states because of current complacency about the situation and about the existence of social stigmas and about discrimination practised against victims of the disease. .
The gender dimension of relationships between men and women, especially the fact that power still resides with the men, was a matter to be resolved through strong advocacy programmes, while a thorough "ventilation" of the HIV/AIDS issue was urgently required within the society in general. To ensure effectiveness in these efforts, Sir Alleyne called for a pan-Caribbean partnership to work regionally in generating support from the civil society, from political leaders, and from departments of government. Additionally, social research was required to provide insights into how people actually behave, and to generate knowledge about the root causes of stigma and discrimination, and about methods for overcoming them.
Focusing on the nexus between population and HIV/AIDS, H.E. Mr. Toshiro Ozawa of Japan described four areas where more effective policy measures and action programmes were urgently required: education, empowerment of women, strengthening partnerships at local, national and international levels, and family planning.
In the education sector, focus was required on children and on primary schooling, as only through knowledge, presented in appropriate ways, could awareness be created. As for measures to empower women, this should help to enhance the ability of women to be an equal decision-maker in matters of sex. Strengthening partnerships, said Ambassador Ozawa, would bring beneficial links with donor countries, international NGOs, and, at national level, with all elements of the civil society, down to the community level. South-south exchanges (such as those practised by the PPD member countries) could also bring benefits from lessons learned. As for family planning, it represented the special point of linkage between population issues and the HIV/AIDS pandemic, especially with the crosscutting areas of reproductive health needs.
As a donor country, Japan was committed, said the Ambassador, to promoting both partnership and ownership arrangements related to the guarantee of human security, as called for in the report of the independent Commission on Human Security, co-chaired by Professor Amartya Sen and Mrs. Sadako Ogata. Japanese initiatives were supportive of population programmes with their reproductive health components, with major funding being directed to the work of the UNFPA, the International Planned Parenthood Federation, and UNAIDS. Significant funding was also being directed to combating a variety of other infectious diseases.
"While our country is fortunate enough to have very low rates of HIV/AIDS infection," Mr. Ozawa remarked, "we are interested in helping to resolve the global problems posed by the pandemic because we know that we cannot have development at home without assuring human security abroad."
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Acting as discussant following the presentations, Mr. Jyoti Singh, Permanent Observer for Partners in Population and Development, said that HIV/AIDS was not only a health issue; it was also a gender issue, security issue and a development issue, with direct links to the MDGs which all nations have subscribed to at the Millennium Summit. There was a need, he stressed, for nations to show political commitment that would promote intersectoral coordination and result in effective response programmes. A practical measure would be the creation of HIV/AIDS units in the relevant government ministries.
Among observations from the invited audience were references to the Uganda HIV/AIDS programme, the involvement of religious leaders and the thought that religion could perhaps play an even greater role in the future. A suggestion was also proposed that population programmes in some African countries might have to take into account a "depopulating effect" caused by HIV/AIDS. This prompted a response from another audience member, who downplayed overreaction to the issue of numbers, suggesting instead that it would be more productive to look broadly at the role of population programmes in Africa today, and to study the impact of the pandemic upon the work force and the aged, especially since grandparents were becoming the real care-givers to children orphaned by HIV/AIDS. Programme actions were required to deal with these critical phenomena.
An NGO representative concerned with community-level work in Africa said she was indeed witness to the destruction of extended family structures caused directly by HIV/AIDS, and she spoke of the critical need for resources to help cope with the resulting dislocations and attendant problems. Additional comments touched on the relationship of civil conflicts to HIV/AIDS, the resulting displacement of population, and the higher incidence of infection rates.
Responding to audience comments, one of the guest presenters spoke of the value of securing strong leadership at national level in countries where the extended family structures were breaking down. In his reply to the question about the direction of population programmes in afflicted countries, Dr. Musinguzi said Uganda was currently going through a demographic transition and it was now evident that the national population programme needed to be adjusted accordingly.
In his closing remarks
Mr. Chowdhury thanked the invited speakers for their insightful presentations.